As hospitals and health systems continue to improve patient experience, it becomes more difficult to differentiate organizations based on HCAHPS scores alone. An emerging trend, sentiment analysis, has the potential to give hospitals an extra edge in deepening their understanding of the patient experience.
Classifying patients' comments
Sentiment analysis applied to patient experience is a systematic analysis of patients' comments on satisfaction surveys. Patients' comments can be broken into their components and classified according to topic, meaning and intensity — whether and how positive or negative. While there are different methods of classifying the components of patients' comments, Press Ganey classifies comments into three categories: people, places and process, each of which have separate topic areas, such as physicians and nurses for the people category. These topics can be further broken down into themes, such as "listens well" and "knowledgeable." Comments are then scored according to their positivity or negativity. Through this process, hospitals can quantify patients' experience.
"The food was good, but the doctor was great."
For example, the comment "The food was good, but the doctor was great" contains information that, when analyzed with thousands of other patients' responses, can provide insights into where the hospital's opportunities for improvement lie. The statement includes two positive sentiments of different levels ("great" is more positive than "good") and is applicable to at least two categories — food and physicians. In aggregate, separating comments into their component parts and analyzing them enables hospital leaders to quantify their organizations' performance in patient experience.
Sentiment analysis as strategy
Classifying comments similarly to HCAHPS categories — physicians, nursing, pain management and discharge — can enhance a hospital's understanding of its HCAHPS scores by providing greater depth. For example, sentiment analysis can separate patients' comments about the provider's responsiveness to pain and the effectiveness of pain management. An analysis led by David Costello, PhD, chief analytics officer at Press Ganey, found that just responding to pain in a timely manner could move survey scores dramatically. More than half of patients claim pain relief once helped, while only 20 percent say staff responded quickly enough to their pain. There is a fivefold sentiment score difference between these two groups. Thus hospitals can target pain responsiveness to improve patient satisfaction.
"In the past, [people] looked at comments directly. Now, they're asking the question, 'Can I use it differently, from a strategic standpoint?'" Dr. Costello says. For example, sentiment analysis can be used to determine an effect of an initiative on patient experience. One hospital wanted to measure the impact of changes in nurse communication on patients' experience. The hospital looked at not only sentiment scores in the category of nurse communication, but could also identify what words and feelings were most associated with that category.
"They were looking for the visceral expressions patients have," Dr. Costello says. "Sometimes the [impact of the] change gets lost when it's numerical; it doesn't get lost when patients say 'Nurses' communication was the greatest experience,' or 'The doctor talked to me in a way I could really understand.' It's a far more powerful response than just the filling of an oval."
Another example of using sentiment analysis as a strategy to improve patient experience is looking at specific themes, such as empathy. Dr. Costello analyzed the relationship between emergency department patients' positive comments on physicians' and nurses' empathy and the overall patient experience score. When there are high nurse empathetic scores, the average ratio of positive to negative comments is 3.3 to 1 compared with the average 1.4 to 1 ratio. This finding shows that focusing on empathy can significantly improve hospitals' patient experience scores. "If I were a hospital administrator, I would ask my trainers how to inject empathy into my staff, doctors and nurses in the way they interact with patients," Dr. Costello says.
A sentiment analysis study also debunked the popular belief that people comment only when they have something negative to say, as Dr. Costello's analysis of more than 12 million inpatient comments found 20 percent more positive comments than negative comments.
Sharing comments with staff
In addition to looking at an analysis of all patients' comments, sentiment analysis can help hospital leaders identify positive comments that can motivate staff. Dr. Costello suggests sharing a few highly positive comments during every weekly meeting to motivate healthcare team members.
Sharing negative comments can help providers identify weaknesses and respond to patients who had a negative experience. For example, sentiment analysis can set aside comments with highly negative words, such as "sue" or "outrageous," so that leaders can meet with the physician to identify the problem and initiate a discussion with the patient. "Negative comments don't always mean it was the deliverer's fault; it [may] mean something else was wrong with the process," Dr. Costello says. "Allow doctors and facilities to pull charts and do process improvement."
Sentiment analysis trajectory
While sentiment analysis is still in its infancy in healthcare, it has been used a great deal in business and in other industries, according to Dr. Costello. "I believe that just like in other industries, five years from now [sentiment analysis] will be a staple for hospitals and provider practices, because capturing the voice of patients is increasingly important," he says.
In addition, as hospitals as a group improve patient experience, the competition for attracting patients will increase. "The points of differentiation between hospitals and providers are getting harder and harder to make," Dr. Costello says. "These insights through sentiments are going to provide that edge to help [organizations] differentiate and create a strategy different from their counterparts that are not doing it today."
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